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READING SUB-TEST – TEXT BOOKLET: PART A

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 Sedation: Iron deficiencies

Text A

Iron deficiency and iron deficiency anaemia are common. The serum ferritin level is the most useful
indicator of iron deficiency, but interpretation can be complex. Identifying the cause of iron
deficiency is crucial. Oral iron supplements are effective first-line treatment. Intravenous iron
infusions, if required, are safe, effective and practical.

Key Points
• Measurement of the serum ferritin level is the most useful diagnostic assay for detecting iron
deficiency, but interpretation may be difficult in patients with comorbidities.
• Identifying the cause of iron deficiency is crucial; referral to a gastroenterologist is often
required.
• Faecal occult blood testing is not recommended in the evaluation of iron deficiency; a
negative result does not impact on the diagnostic evaluation.
• Oral iron is an effective first-line treatment, and simple strategies can facilitate patient
tolerance.
• For patients who cannot tolerate oral therapy or require more rapid correction of iron
deficiency, intravenous iron infusions are safe, effective and practical, given the short
infusion times of available formulations.
• Intramuscular iron is no longer recommended for patients of any age.

Text B

Treatment of infants and children

Although iron deficiency in children cannot be corrected solely by dietary change, dietary advice
should be given to parents and carers. Cows’ milk is low in iron compared with breast milk and
infant formula, and enteropathy caused by hypersensitivity to cows’ milk protein can lead to
occult gastrointestinal blood loss. Excess cows’ milk intake (in lieu of iron-rich solid foods) is the
most common cause of iron deficiency in young children. Other risk factors for dietary iron
deficiency include late introduction of or insufficient iron-rich foods, prolonged exclusive
breastfeeding and early introduction of cows’ milk.

Adult doses of iron can be toxic to children, and paediatric-specific protocols on iron
supplementation should be followed. The usual paediatric oral iron dosage is 3 to 6mg/kg
elemental iron daily. If oral iron is ineffective or not tolerated then consider other causes of
anaemia, referral to a specialist paediatrician and use of IV iron.
Text C
AN ALGORITHM FOR THE IDENTIFICATION AND MANAGEMENT OF ADULTS WITH IRON DEFICIENCY

Patient presents with clinically suspected iron deficiency

• member of high-risk population (infants, children, menstruating or pregnant
women, vegetarians)
• clinical or laboratory evidence of iron deficiency or anaemia
• micocytosis or hypochromasia (MCV or MCH below laboratory lower limit of
normal)

• Evaluate clinically for

- potential contributors and risk factors for iron deficiency
- inflammatory states or other disorders that may influence interpretation of FBC or iron studies
• Measure serum ferritin level if not already measured

Serum ferritin <30mcg/L Serum ferritin 30-100 mcg/L Serum ferritin >100 mcg/L

Iron deficiency • Borderline iron stores • Iron deficiency unlikely

• Iron deficiency not excluded as serum • If anaemia present then consider
ferritin level may be raised because of functional iron deficiency; specialist input
inflammation may be required

Evaluate for cause (see If iron deficiency felt If inflammatory state

Box 2) to be contributory identified

• Replace iron • Correct inflammatory state

- give oral iron preparation • Selected patients may still
- if rapid correction required (poorly tolerated anaemia) benefit from iron replacement;
or oral therapy unsuccessful then give intravenous iron specialist input advised

• Re-evaluate 1 to 2 weeks after therapy to ensure iron stores are replete and anaemia improving
• Re-evaluate 3 to 6 months after therapy to ensure iron repletion is maintained and anaemia resolved

If iron deficiency recurs If anaemia identified

• repeat evaluation for additional or recurrent source of blood loss; with normal iron stores
consider all diagnoses in Box 2 • evaluate for other
• refer men aged over 40 years and women over 50 years for causes of anaemia
endoscopy and colonoscopy regardless of gastrointestinal symptoms
Text D

END OF PART A
THIS TEXT BOOKLET WILL BE COLLECTED
 READING SUB-TEST – QUESTION PAPER: PART B

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 Part B

In this part of the test, there are six short extracts relating to the work of health professionals. For
questions 1-6, choose answer (A, B or C) which you think fits best according to the text.

1. The code of conduct applies to

A doctors friending patients on Facebook.

B privacy settings when using social media.

C electronic and face to face communication.

Professional obligations

The Code of conduct contains guidance about the required standards of

professional behaviour, which apply to registered health practitioners whether
they are interacting in person or online. The Code of conduct also articulates
standards of professional conduct in relation to privacy and confidentiality of
patient information, including when using social media. For example, posting
unauthorised photographs of patients in any medium is a breach of the
patient’s privacy and confidentiality, including on a personal Facebook site or
group, even if the privacy settings are set at the highest setting (such as for a
closed, ‘invisible’ group).

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 2. Why does dysphagia often require complex management?

A Because it negatively influences the cardiac system.

B Because it is difficult contrast complex and non-complex cases.

C Because it seldom occurs without other symptoms.

6.1 General principles

Dysphagia management may be complex and is often multi-factorial in nature. The

speech pathologist’s understanding of human physiology is critical. The swallowing
system works with the respiratory system. The respiratory system is in turn influenced
by the cardiac system, and the cardiac system is affected by the renal system. Due to
the physiological complexities of the human body, few clients present with dysphagia in
isolation.

6.2 Complex vs. non-complex cases

Broadly the differentiation between complex and non-complex cases relates to an

appreciation of client safety and reduction in risk of harm. All clinicians, including new
graduates, should have sufficient skills to appropriately assess and manage non-
complex cases. Where a complex client presents, the skills of an advanced clinician are
required. Supervision and mentoring should be sought for newly graduated clinicians or
those with insufficient experience to manage complex cases.

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 3. The main point of the extract is

A how to find documents about infection control in Australia.

B that dental practices must have a guide for infection control.

C that dental infection control protocols must be updated.

1 Documentation
1.1 Every place where dental care is provided must have the following documents in

either hard copy or electronic form (the latter includes guaranteed Internet access).

Every working dental practitioner and all staff must have access to:

a). a manual setting out the infection control protocols and procedures used in that

practice, which is based on the documents listed at sections 1.1(b), (c) and (d) of

these guidelines and with reference to the concepts in current practice noted in the

documents listed under References in these guidelines

b). The current Australian Dental Association Guidelines for Infection Control

(available at: http://www.ada.org.au)

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 4. Negative effects from prescription drugs are often

A avoidable in young people.

B unpredictable in the elderly.
C caused by miscommunication.

Reasons for Drug-Related Problems: Manual for Geriatrics Specialists

Adverse drug effects can occur in any patient, but certain characteristics of the elderly
make them more susceptible. For example, the elderly often take many drugs
(polypharmacy) and have age-related changes in pharmacodynamics and
pharmacokinetics; both increase the risk of adverse effects.
At any age, adverse drug effects may occur when drugs are prescribed and taken
appropriately; e.g., new-onset allergic reactions are not predictable or preventable.
However, adverse effects are thought to be preventable in almost 90% of cases in the
elderly (compared with only 24% in younger patients). Certain drug classes are commonly
involved: antipsychotics, antidepressants, and sedative-hypnotics.
In the elderly, a number of common reasons for adverse drug effects, ineffectiveness, or
both are preventable. Many of these reasons involve inadequate communication with
patients or between health care practitioners (particularly during health care transitions).

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 5. The guideline tries to use terminology that

A presents value-free information about different social groups.

B distinguishes disadvantaged groups from the traditional majority.

C clarifies the proportion of each race, gender and culture.

Terminology
Terminology in this guideline is a difficult issue since the choice of terminology used
to distinguish groups of persons can be personal and contentious, especially when
the groups represent differences in race, gender, sexual orientation, culture or other
characteristics. Throughout the development of this guideline the panel endeavoured
to maintain neutral and non-judgmental terminology wherever possible. Terms such
as “minority”, “visible minority”, “non-visible minority” and “language minority” are used
in some areas; when doing so the panel refers solely to their proportionate numbers
within the larger population and infers no value on the term to imply less importance
or less power. In some of the recommendations the term “under-represented groups”
is used, again, to refer solely to the disproportionate representation of some citizens
in those settings in comparison to the traditional majority.

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 6. What is the purpose of this extract?

A To illustrate situations where patients may find it difficult to give negative feedback.

B To argue that hospital brochures should be provided in many languages.

C To provide guidance to people who are victims of discrimination.

Special needs

Special measures may be needed to ensure everyone in your client base is aware of your consumer feedback
policy and is comfortable with raising their concerns. For example, should you provide brochures in a
language other than English?

Some people are less likely to complain for cultural reasons. For example, some Aboriginal people may be
culturally less inclined to complain, particularly to non-Aboriginal people. People with certain conditions such
as hepatitis C or a mental illness, may have concerns about discrimination that will make them less likely to
speak up if they are not satisfied or if something is wrong.

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 READING SUB-TEST – QUESTION PAPER: PART C

CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
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PROFESSION:
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TEST DATE:
CANDIDATE SIGNATURE

INSTRUCTIONS TO CANDIDATES:

DO NOT open this Question Paper until you are told to do so.

One mark will be granted for each correct answer.

Answer ALL questions. Marks are NOT deducted for incorrect answers.

At the end of this test, hand in this Question Paper.

DO NOT remove OET material from the test room.

HOW TO ANSWER THE QUESTIONS:

Mark your answers on this Question Paper by filling in the circle using a 2B pencil.

Example:
A
B
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C

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 Part C
In this part of the test, there are two texts about different aspects of healthcare. For questions 7-22,
choose the answer (A, B, C or D) which you think fits best according to the text.

Text 1: Difficult-to-treat depression

Depression remains a leading cause of distress and disability worldwide. In one country’s
survey of health and wellbeing in 2007, 7.2% of people surveyed had experienced a mood
(affective) disorder in the previous 12 months. Those affected reported a mean of 11.7
disability days when they were “completely unable to carry out or had to cut down on their
usual activities owing to their health” in the previous 4 weeks. There was also evidence of
substantial under-treatment: amazingly only 35% of people with a mental health problem had
a mental health consultation during the previous 12 months. Three-quarters of those seeking
help saw a general practitioner (GP). In the 2015–16 follow-up survey, not much had
changed. Again, there was evidence of substantial unmet need, and again GPs were the
health professionals most likely to be providing care.

While GPs have many skills in the assessment and treatment of depression, they are often
faced with people with depression who simply do not get better, despite the use of proven
psychological or pharmacological therapies. GPs are well placed in one regard, as they often
have a longitudinal knowledge of the patient, understand his or her circumstances, stressors
and supports, and can marshal this knowledge into a coherent and comprehensive
management plan. Of course, GPs should not soldier on alone if they feel the patient is not
getting better.

In trying to understand what happens when GPs feel “stuck” while treating someone with
depression, a qualitative study was undertaken that aimed to gauge the response of GPs to
the term “difficult-to-treat depression”. It was found that, while there was confusion around
the exact meaning of the term, GPs could relate to it as broadly encompassing a range of
individuals and presentations. More specific terms such as “treatment-resistant depression”
are generally reserved for a subgroup of people with difficult-to-treat depression that has
failed to respond to treatment, with particular management implications.

One scenario in which depression can be difficult to treat is in the context of physical illness.
Depression is often expressed via physical symptoms, however it is also true is that people
with chronic physical ailments are at high risk of depression. Functional pain syndromes
where the origin and cause of the pain are unclear, are particularly tricky, as complaints of
pain require the clinician to accept them as “legitimate”, even if there is no obvious physical
cause. The use of analgesics can create its own problems, including dependence. Patients
with comorbid chronic pain and depression require careful and sensitive management and a
long-term commitment from the GP to ensure consistency of care and support.

It is often difficult to tackle the topic of depression co-occurring with borderline personality
disorder (BPD). People with BPD have, as part of the core disorder, a perturbation of affect
associated with marked variability of mood. This can be very difficult for the patient to deal
with and can feed self-injurious and other harmful behaviour. Use of mentalisation-based
techniques is gaining support, and psychological treatments such as dialectical behaviour
therapy form the cornerstone of care. Use of medications tends to be secondary, and
prescription needs to be judicious and carefully targeted at particular symptoms. GPs can
play a very important role in helping people with BPD, but should not “go it alone”, instead
ensuring sufficient support for themselves as well as the patient.

Another particularly problematic and well-known form of depression is that which occurs in
the context of bipolar disorder. Firm data on how best to manage bipolar depression is
surprisingly lacking. It is clear that treatments such as unopposed antidepressants can make
matters a lot worse, with the potential for induction of mania and mood cycle acceleration.
However, certain medications (notably, some mood stabilisers and atypical antipsychotics)
can alleviate much of the suffering associated with bipolar depression. Specialist psychiatric
input is often required to achieve the best pharmacological approach. For people with bipolar
disorder, psychological techniques and long-term planning can help prevent relapse. Family
education and support is also an important consideration.
Text 1: Questions 7-14

7. In the first paragraph, what point does the writer make about the treatment of depression?

A 75% of depression sufferers visit their GP for treatment.

B GPs struggle to meet the needs of patients with depression.

C Treatment for depression takes an average of 11.7 days a month.

D Most people with depression symptoms never receive help.

8. In the second paragraph, the writer suggests that GPs

A are in a good position to conduct long term studies on their patients.

B lack training in the treatment and assessment of depression.

C should seek help when treatment plans are ineffective.

D sometimes struggle to create coherent management plans.

9. What do the results of the study described in the third paragraph suggest?

A GPs prefer the term “treatment resistant depression” to “difficult-to-treat depression”.

B Patients with “difficult-to-treat depression” sometimes get “stuck” in treatment.

C The term “difficult-to-treat depression” lacks a precise definition.

D There is an identifiable sub-group of patients with “difficult-to-treat depression”.

10. Paragraph 4 suggests that

A prescribing analgesics is unadvisable when treating patients with depression.

B the co-occurrence of depression with chronic conditions makes it harder to treat.

C patients with depression may have undiagnosed chronic physical ailments.

D doctors should be more careful when accepting pain complaints as legitimate.

11. According to paragraph 5, people with BPD have

A depression occurring as a result of the disorder

B noticeable mood changes which are central to their disorder.

C a tendency to have accidents and injure themselves.

D problems tackling the topic of their depression.

12. In paragraph 5, what does the phrase ‘form the cornerstone’ mean regarding BPD treatment?

A Psychological therapies are generally the basis of treatment.

B There is more evidence for using mentalisation than dialectical behaviour therapy.

C Dialectical behaviour therapy is the optimum treatment for depression.

.
D In some unusual cases prescribing medication is the preferred therapy.

13. In paragraph 6, what does the writer suggest about research into bipolar depression management?

A There is enough data to establish the best way to manage bipolar depression.

B Research hasn’t provided the evidence for an ideal management plan yet.

C A lack of patients with the condition makes it difficult to collect data on its management.

D Too few studies have investigated the most effective ways to manage this condition.

14. In paragraph 6, what does the writer suggest about the use of medications when treating bipolar
depression?
A There is evidence for the positive and negative results of different medications.

B Medications typically make matters worse rather than better.

C Medication can help prevent long term relapse when combined with family education.

D Specialist psychiatrists should prescribe medication for bipolar disorder rather than GPs.
Text 2: Are the best hospitals managed by doctors?

Doctors were once viewed as ill-prepared for leadership roles because their selection and
training led them to become “heroic lone healers.” However, the emphasis on patient-
centered care and efficiency in the delivery of clinical outcomes means that physicians are
now being prepared for leadership. The Mayo Clinic is America’s best hospital, according to
the 2016 US News and World Report (USNWR) ranking. Cleveland Clinic comes in second.
The CEOs of both — John Noseworthy and Delos “Toby” Cosgrove — are highly skilled
physicians. In fact, both institutions have been physician-led since their inception around a
century ago. Might there be a general message here?

A study published in 2011 examined CEOs in the top-100 hospitals in USNWR in three key
medical specialties: cancer, digestive disorders, and cardiovascular care. A simple question
was asked: are hospitals ranked more highly when they are led by medically trained doctors
or non-MD professional managers? The analysis showed that hospital quality scores are
approximately 25% higher in physician-run hospitals than in manager-run hospitals. Of
course, this does not prove that doctors make better leaders, though the results are surely
consistent with that claim.

Other studies find a similar correlation. Research by Bloom, Sadun, and Van Reenen
revealed how important good management practices are to hospital performance. However,
they also found that it is the proportion of managers with a clinical degree that had the
largest positive effect; in other words, the separation of clinical and managerial knowledge
inside hospitals was associated with more negative management outcomes. Finally, support
for the idea that physician-leaders are advantaged in healthcare is consistent with
observations from many other sectors. Domain experts – “expert leaders” (like physicians in
hospitals) — have been linked with better organizational performance in settings as diverse
as universities, where scholar-leaders enhance the research output of their organizations, to
basketball teams, where former All-Star players turned coaches are disproportionately
linked to NBA success.

What are the attributes of physician-leaders that might account for this association with
enhanced organizational performance? When asked this question, Dr. Toby Cosgrove, CEO
of Cleveland Clinic, responded without hesitation, “credibility … peer-to-peer credibility.” In
other words, when an outstanding physician heads a major hospital, it signals that they have
“walked the walk”. The Mayo website notes that it is physician-led because, “This helps
ensure a continued focus on our primary value, the needs of the patient come first.” Having
spent their careers looking through a patient-focused lens, physicians moving into executive
positions might be expected to bring a patient-focused strategy.
In a recent study that matched random samples of U.S. and UK employees with employers,
we found that having a boss who is an expert in the core business is associated with high
levels of employee job satisfaction and low intentions of quitting. Similarly, physician-leaders
may know how to raise the job satisfaction of other clinicians, thereby contributing to
enhanced organizational performance. If a manager understands, through their own
experience, what is needed to complete a job to the highest standard, then they may be
more likely to create the right work environment, set appropriate goals and accurately
evaluate others’ contributions.

Finally, we might expect a highly talented physician to know what “good” looks like when
hiring other physicians. Cosgrove suggests that physician-leaders are also more likely to
tolerate innovative ideas like the first coronary artery bypass, performed by René Favaloro at
the Cleveland Clinic in the late ‘60s. Cosgrove believes that the Cleveland Clinic unlocks
talent by giving safe space to people with extraordinary ideas and importantly, that
leadership tolerates appropriate failure, which is a natural part of scientific endeavour and
progress.

The Cleveland Clinic has also been training physicians to lead for many years. For example,
a cohort-based annual course, “Leading in Health Care,” began in the early 1990s and has
invited nominated, high-potential physicians (and more recently nurses and administrators)
to engage in 10 days of offsite training in leadership competencies which fall outside the
domain of traditional medical training. Core to the curriculum is emotional intelligence (with
360-degree feedback and executive coaching), teambuilding, conflict resolution, and
situational leadership. The course culminates in a team-based innovation project presented
to hospital leadership. 61% of the proposed innovation projects have had a positive
institutional impact. Moreover, in ten years of follow-up after the initial course, 48% of the
physician participants have been promoted to leadership positions at Cleveland Clinic.
Text 2: Questions 15-22

15. In paragraph 1, why does the writer mention the Mayo and Cleveland Clinics?

A To highlight that they are the two highest ranked hospitals on the USNWR

B To introduce research into hospital management based in these clinics

C To provide examples to support the idea that doctors make good leaders

D To reinforce the idea that doctors should become hospital CEOs

16. What is the writer’s opinion about the findings of the study mentioned in paragraph 2?

A They show quite clearly that doctors make better hospital managers.

B They show a loose connection between doctor-leaders and better management.

C They confirm that the top-100 hospitals on the USNWR ought to be physician-run.

D They are inconclusive because the data is insufficient.

17. Why does the writer mention the research study in paragraph 3?

A To contrast the findings with the study mentioned in paragraph 2

B To provide the opposite point of view to his own position

C To support his main argument with further evidence

D To show that other researchers support him

18. In paragraph 3, the phrase ‘disproportionately linked’ suggests

A all-star coaches have a superior understanding of the game.

B former star players become comparatively better coaches.

C teams coached by former all-stars consistently outperform other teams.

D to be a successful basketball coach you need to have played at a high level.

19. In the fourth paragraph, what does the phrase “walked the walk,” imply about physician-
leaders?
A They have earned credibility through experience.

B They have ascended the ranks of their workplace.

C They appropriately incentivise employees.

D They share the same concerns as other doctors.

20. In paragraph 6, the writer suggests that leaders promote employee satisfaction because

A they are often cooperative.

B they tend to give employees positive evaluations.

C they encourage their employees not to leave their jobs.

D they understand their employees’ jobs deeply.

21. In the seventh paragraph, why is the first coronary artery bypass operation mentioned?

A To demonstrate the achievements of the Cleveland clinic

B To present René Favaloro as an exemplar of a ‘good’ doctor

C To provide an example of an encouraging medical innovation

D To show how failure naturally contributes to scientific progress

22. In paragraph 8, what was the outcome of the course “Leading in Health Care”?

A The Cleveland Clinic promoted almost half of the participants.

B 61% of innovation projects lead to participants being promoted.

C Some participants took up leadership roles outside the medical domain.

D A culmination of more team-based innovations.

 Reading Part A: Answer Key
Reading Part A: Answer Key

1 b

2 c

3 a

4 b

5 d

6 a

7 d

8 <30 mcg/L / less than 30 mcg/L / < 30 mcg / L / <30mcg/L

9 excess cow’s milk / excess cow milk / excess cows’ milk / excessive cow’s milk / excessive cow milk / excessive cows’
milk / excess cow’s milk intake / excess cow milk intake / excess cows’ milk intake / excessive cow’s milk intake /
excessive cow milk intake / excessive cows’ milk intake

10 iron polymaltose

11 consider other cases / evaluate other causes / evaluate for other causes

12 1 to 2 weeks / one to two weeks / 1-2 weeks / 1 - 2 weeks

13 ferric carboxymaltose

14 oral iron / oral iron supplements

15 low in iron

16 adult doses of iron / adult iron doses

17 endoscopy and colonoscopy / colonoscopy and endoscopy

18 3 times per week / three times per week / 3 times a week / three times a week / 3 times weekly / three times weekly

19 in patients with comorbidities

20 tolerate oral iron / tolerate oral iron therapies / tolerate oral iron therapy

Close
 OET Reading Part B: Answer Key
1. C

2. C

3. B

4. C

5. A

6. A

Close
 Reading Part C: Answer Key
Reading Part C: Answer Key

7 d

8 c

9 c

10 b

11 b

12 a

13 b

14 a

15 c

16 a

17 c

18 b

19 a

20 d

21 c

22 a

Close